Basic Information
Provider Information | |||||||||
NPI: | 1679576862 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ALGONQUIN FIRE PROTECTION DISTRICT | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ALGONQUIN LAKE IN THE HILLS FIRE PROTECTION DISTRICT | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 457 | ||||||||
Address2: |   | ||||||||
City: | WHEELING | ||||||||
State: | IL | ||||||||
PostalCode: | 600900457 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8475778811 | ||||||||
FaxNumber: | 8475779515 | ||||||||
Practice Location | |||||||||
Address1: | 1020 W ALGONQUIN RD | ||||||||
Address2: |   | ||||||||
City: | LAKE IN THE HILLS | ||||||||
State: | IL | ||||||||
PostalCode: | 601563500 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8476588233 | ||||||||
FaxNumber: | 8478542609 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/23/2005 | ||||||||
LastUpdateDate: | 05/19/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GUETSCHOW | ||||||||
AuthorizedOfficialFirstName: | STEVE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
AuthorizedOfficialTelephone: | 8476588223 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | CHIEF | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 7957 | IL | Y |   | Transportation Services | Ambulance | Land Transport |
ID Information
ID | Type | State | Issuer | Description | 356195100 | 01 | IL | DEPT OF LABOR OWCP | OTHER | 5621609 | 01 | IL | BCBS PROVIDER NUMBER | OTHER | 590012475 | 01 | IL | MEDICARE RAILROAD | OTHER |